Mechanical Ventilation Doubles For Persons With Advanced Dementia

MedicalResearch.com Interview with:

Joan M. Teno, MD, MS Department of Gerontology and Geriatrics, Cambia Palliative Care Center of Excellence University of Washington Medicine Seattle, Washington

Dr. Joan Teno

Joan M. Teno, MD, MS
Department of Gerontology and Geriatrics,
Cambia Palliative Care Center of Excellence
University of Washington Medicine
Seattle, Washington

MedicalResearch.com: What is the background for this study?

Response: An important challenge for our health care system is effectively caring for persons that high-need, high-cost — persons afflicted with advanced dementia and severe functional impairment are among these persons, with substantial need and if hospitalized in the ICU and mechanically ventilated are high cost patients, who are unlikely to benefit from this level of care and our best evidence suggest the vast majority of persons would not want this care. In a previous study, we interviewed families of advance dementia with 96% starting the goals of care are to focus comfort. Mechanical ventilation in some cases may be life saving, but in cases such as those with advanced dementia and severe functional impairment, they may result in suffering without an improvement in survival.

MedicalResearch.com: What are the main findings?

Response: There are three key findings from our study:

1. Over a 13 year period, the use of mechanical ventilation for persons with advanced dementia and severe functional impairment had doubled and nearly tripled in those person admitted to hospital with pneumonia or septicemia.

2. 1-year survival has not substantially improved over a 13 year period of time

3. Advanced dementia patients admitted to hospitals that increase their ICU beds by 10 – had 6% increase risk of mechanical ventilation – this finding calls to attention to not only focus on interventions on advance care planning in NH, improved decision making in the hospital, but focus on address the striking difference in regional growth of ICU beds to ensure that an excess capacity is not resulting in care that potentially is not consistent with the patient/family preferences and with their clinical condition.

MedicalResearch.com: What should readers take away from your report?

Response: Multifacted and sustained interventions are needed to ensure that persons with advanced dementia and severe functional impairment get care consistent with their preferences and the likely outcomes of care. Consideration needs to be given to national strategy for growth of ICU beds.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We need multifaceted interventions to ensure that care among this vulnerable, frail population is consistent with their preferences.

If you are family member of persons afflicted with dementia, it is very important to plan ahead – and discuss with health care providers regarding your family members’ goals of care and then, develop a plan to ensure those wishes are honored.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

Joan M. Teno MD, MS, Pedro Gozalo PhD, Nita Khandelwal MD, MS, J. Randall Curtis MD, MPH, David Meltzer MD, PhD, Ruth Engelberg PhD, Vincent Mor PhD
JAMA Intern Med. 2016 Oct 10. doi: 10.1001/jamainternmed.2016.5964. [Epub ahead of print]

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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